|
MORPHINE 4 MG/ML INTRAVENOUS SYRINGE [117338]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
|
|
MORPHINE 4 MG/ML INTRAVENOUS SYRINGE [117338]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.55
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.59
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.40
|
| Rate for Payer: University Health Alliance Commercial |
$6.56
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
NDC 00406800330
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$55.29 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Health Management Network Commercial |
$48.45
|
| Rate for Payer: MDX Hawaii PPO |
$55.29
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
NDC 27808008201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
NDC 00406800330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.07 |
| Max. Negotiated Rate |
$55.29 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$54.15
|
| Rate for Payer: Health Management Network Commercial |
$48.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.07
|
| Rate for Payer: MDX Hawaii PPO |
$55.29
|
| Rate for Payer: University Health Alliance Commercial |
$41.55
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
NDC 27808008201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.85
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.13
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
| Rate for Payer: University Health Alliance Commercial |
$45.92
|
|
|
MORPHINE CONCENTRATE 20 MG/ML ORAL SOLN SYRINGE [4080141]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00004080109
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
MORPHINE CONCENTRATE 20 MG/ML ORAL SOLN SYRINGE [4080141]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00004080109
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 42858080401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
|
|
MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 42858080401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.04
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
| Rate for Payer: University Health Alliance Commercial |
$2.92
|
|
|
MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
NDC 00406839023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$27.16 |
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.60
|
| Rate for Payer: Health Management Network Commercial |
$23.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.28
|
| Rate for Payer: MDX Hawaii PPO |
$27.16
|
| Rate for Payer: University Health Alliance Commercial |
$20.41
|
|
|
MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
NDC 00406839001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$27.16 |
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.60
|
| Rate for Payer: Health Management Network Commercial |
$23.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.28
|
| Rate for Payer: MDX Hawaii PPO |
$27.16
|
| Rate for Payer: University Health Alliance Commercial |
$20.41
|
|
|
MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
NDC 00406839023
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$27.16 |
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Health Management Network Commercial |
$23.80
|
| Rate for Payer: MDX Hawaii PPO |
$27.16
|
|
|
MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
NDC 00406839001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$27.16 |
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Health Management Network Commercial |
$23.80
|
| Rate for Payer: MDX Hawaii PPO |
$27.16
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 68084015711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 00406831562
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 00406831562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.60
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.08
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
| Rate for Payer: University Health Alliance Commercial |
$5.83
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 00406831523
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.60
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.08
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
| Rate for Payer: University Health Alliance Commercial |
$5.83
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 68084015711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.65
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.57
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
| Rate for Payer: University Health Alliance Commercial |
$5.10
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 00406831523
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 00406833001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.12
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
| Rate for Payer: University Health Alliance Commercial |
$8.75
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 00406833062
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 68084015801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.12
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
| Rate for Payer: University Health Alliance Commercial |
$8.75
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 00406833023
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 68084015801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
|
